Assistant Professor Lim Toon Wei, President of Singapore Cardiac Society
Clinical Assistant Professor Colin Yeo, Organising Chairman of SCS’ 34th Annual Scientific Meeting
Distinguished Guests
Ladies and Gentlemen
I am happy to join you today for the Singapore Cardiac Society’s 34th Annual Scientific Meeting. This is a significant year, as the Society is also celebrating its 50th anniversary.
The Last 50 Years
2. Looking back, in the last 50 years, there were many breakthroughs and innovations in the practice of cardiology and cardiac surgery. This includes the echocardiogram to do ultrasound of the heart, coronary angiography to image heart arteries, pacemakers, angioplasty and stenting to widen arteries. Later on, stents came with special medication coatings to reduce the probability that a re-narrowing of arteries occurs.
3. Locally, there were many firsts for Singapore, such as the first heart operation, first heart bypass, first heart transplant. Over the years, help to those who suffered a heart attack became more prompt and timely. Our median door-to-balloon time in 2020 was 54 minutes, way below the 90 minutes target recommended by the American Heart Association. This would not have been possible without the continued efforts by our healthcare teams and hospitals.
4. Even when COVID-19 ground international travel to a halt and made economic and social activities sluggish, scientific and medical technology continued to advance. This includes improvements in cardiovascular disease management, or CVD.
5. For example, we adopted telemedicine, such as teleconsultations, for cardiac patients, and soon this may become part of routine care. Our health clusters have started to remotely monitor heart failure patients and those recovering from acute myocardial infarction, or AMI.
The Next 50 Years
6. I have no doubt the practice of cardiology will continue to advance. Medical science is at the cusp of major breakthroughs, due to advancement in precision medicine, gene editing, and the deploying of artificial intelligence.
7. Singapore is supporting research and development work in these areas. We are embarking on a unique and ambitious SG100K project, where we conduct full genome sequencing for 100,000 Singaporeans, and monitor and track their health over time. This will give us profound insights in understanding the interaction of nature – what we are born with, and nurture – the social determinants of health.
8. We should continue to embrace medical advancements, including revolutionary changes, to deliver better health outcomes for our people. But this is going to be an immensely complex endeavour. We need to seize the opportunities and guard the downsides. For example, frontier medicine may be promising but works only on a selected few, and we need to maintain discipline in clinical development and assessment of cost effectiveness before mass deployment. As medical science starts to intervene at the level of the basic building blocks of life, we need to ensure that we continue to clearly define and uphold our ethical and moral standards.
9. These will no doubt be major topics to be discussed in the coming years. In the meantime, there are many imperatives in the clear and present, many ‘no-regrets’ moves that can improve the cardiac health of our population.
State of CVD in Singapore
10. Let us first review the state of the heart in Singapore.
11. The COVID-19 pandemic was a challenging time for the practice of cardiology. During the COVID-19 pandemic, from January 2020 to June 2022, we observed that death rates due to ischaemic heart disease had increased, compared to pre-pandemic levels. This is not surprising, as it is well-established that viral infections, including COVID-19 infections, can worsen underlying medical conditions and trigger heart failures.
12. Now that the worst of the pandemic is over, I believe this spiky challenge will be behind us. With the noise removed, we can see with greater clarity the longer secular trend of ageing and deteriorating health.
13. The number of AMI episodes increased from about 7,400 episodes in 2010, to around 11,700 in 2020. Since 2010, CVD accounted for about 33% of all deaths in Singapore. It is high, but fortunately steady and not worsening. However the signs are worrying, as the prevalence of obesity, hypertension and hyperlipidaemia is rising in Singapore.
14. We know what is driving these trends. Better quality of life has generally lowered the incidence of severe diseases and extended lifespan, but ironically, also adding to diseases of affluence. Food has become richer and less healthy. The working life of Singaporeans is increasingly becoming more sedentary, behind a computer. Then when it comes to leisure time, devices took over the computer, and displaced outdoor sports and activities.
15. Hence, we observe rising trends in CVD risk factors, such as obesity, hyperlipidaemia, and hypertension. So from lifestyle habits to risk factors to cardiovascular disease – we are already on this advancing travellator.
16. The good news is that these CVD risk factors can be mitigated by our everyday lifestyle choices. The bad news is that it is not easy to make people change lifestyle choices. But we are making a concerted, national and determined effort to tackle this problem.
Empowering residents to lead healthier lifestyles
17. That is why the Ministry of Health (MOH) is embarking on Healthier SG. I am sure everyone is already familiar with what the strategy is about. It is our effort to reshape lifestyles. We can’t change it for people – they have to want to do it – but we will roll out the right support systems and incentives for individuals to make the right health choices for themselves.
18. To encourage individuals to move more, the Health Promotion Board (HPB) will work with partners to proliferate physical activity programmes in the community. They have to be ubiquitous, predictable – held with consistent frequencies, at the same time and place – and inclusive – by welcoming everyone who simply turns up. Many Singaporeans are also self-directed in their exercise regimes. The National Steps Challenge and the Healthy 365 app will encourage all these efforts.
19. To encourage individuals to eat better, MOH and HPB have put in place measures to enable Singaporeans to make healthier food choices such as through the Healthier Choice Symbol. More recently, we implemented Nutri-Grade labelling requirements and advertising prohibitions for pre-packaged sugar sweetened beverages. It has been very effective. In fact, we have observed how pre-packaged drink producers have reduced sugar levels, changed formulations, and reduced demand for these beverages over time. The impact we are delivering is almost equivalent to the sugar tax in the UK. For us, we did not implement a sugar tax, yet merely through additional labelling requirements, people are starting to make that switch and changing their choices. In a further push to help Singaporeans reduce their sugar and saturated fat intake, these will be extended to freshly prepared beverages from the end of this year.
20. We also need to urgently lower Singaporeans’ daily sodium intake to reduce their risk of hypertension. More lower sodium alternatives, such as potassium salt, have been made available in the retail and food service sectors. More importantly, we simply need to cut down on the use of salt and sauces in cooking. This requires better cooking and use of ingredients, and on the diner’s part, an appreciation of natural flavours.
21. To encourage individuals to stop smoking, tobacco tax has gone up again, and we are stepping up enforcement against vaping. Smoking cessation programmes are made available to support smokers to quit smoking and sustain a nicotine-free lifestyle.
22. Move more, eat better, stop smoking – these are simple lifestyle choices, but there is also much inertia. I have talked about the initiatives to support them, but someone needs to nudge and guide individuals to do so.
23. We envisage this role to be played by our family doctors. They have always been well-respected by residents, and often regarded as trusted counsellors and confidants. But this is eroding. Over the years, fewer people visit a regular doctor and have held a dedicated patient-family doctor relationship. Today, only three in five Singaporeans visit a regular family doctor.
24. Health seeking habits have also changed. Today, many only visit a family doctor when they have common ailments or need a medical certificate for school or work. Sometimes, we hear of patients who visit various specialist doctors, including cardiologists, but do not have a regular family doctor who can help to manage their overall condition and improve their health.
25. We will reverse these through Healthier SG. We encourage all Singaporeans to enrol in Healthier SG when invited to do so and stay with a regular family doctor.
26. A regular patient-doctor relationship facilitates a continuous line of care. It puts the family doctor in a better position to encourage residents and their family members to take preventive health actions, such as stop smoking, exercise more, or undergo regular health screenings. Family doctors can help residents influence and shape the environmental determinants of their health, rather than just address specific ailments and discomfort.
The Family Doctor-Specialist Partnership
27. As family doctors play an expanding role in preventive care and maintaining the health of our population, we need to strengthen the partnership between them and specialist doctors. The handshakes need to be firm, and the process seamless and smooth.
28. Where a family doctor cannot prevent a deterioration, or detect a disease that is more serious or complex, he will need to refer the patient to specialist care.
29. To illustrate, MOH has developed preventive care protocols that outline recommended health screenings, medications and lifestyle adjustments. These also include guidelines to ensure timely and appropriate referrals to specialist and acute care when necessary.
30. Conversely, where a specialist like a cardiologist assesses that a patient will benefit from preventive care, change of lifestyles or routine management of his chronic disease, he can refer the patient to the family doctor. The family doctor will support them in adhering to recommended care to keep their chronic conditions under control.
31. What does this mean to patients? MOH is already getting queries from patients with chronic conditions, asking if they can continue to see their specialists after Healthier SG is implemented. They certainly can, but the patient will benefit more from having two doctors – a specialist plus a family doctor, one in a specialist centre and the other in the community – to look after different aspects of his health.
32. Under Healthier SG, we will actively strengthen shared care management of patients with chronic diseases.
Matters of the Heart
33. Health is a topic close to our hearts. At an occasion like this – the Cardiac Society’s annual meeting – I would say it is deep in your hearts.
34. I thank SCS and the participants here today for continuing to advance cardiovascular medicine, and for supporting CVD prevention and management in Singapore. I wish all of you a fruitful and enriching meeting ahead. Thank you.